Underserved and Overcharged

A Benzie County couple’s struggle with the state health-care bureaucracy is a snapshot of life in poverty.

Gary and Sandra Houghtaling live in a cabin they built two decades ago on 10 acres. It sits just off a pockmarked dirt road that likes east of Beulah and south of Honor in Homestead Township, a deep rural patchwork of trees and fields that feels like the middle of nowhere.

Gary, 70, and Sandra, 60, survive on a small fixed income that falls under the poverty level. The couple keeps track of every dollar they spend.

That’s why, when they noticed clerical errors on locally administered health care claims the couple says cost them about $400, they complained to anyone they could. For many people, the loss of $400 wouldn’t be catastrophic. But the Houghtalings said, for them, it has meant real pain and suffering.

The couple — who receives care through the Healthy Michigan Plan administered by the Benzie County office of the Michigan Department of Health and Human Services — has spent years trying to correct the problem. In April, the state finally responded, with a refund of $21. In July, the couple received a letter that included an apology.

That’s not enough, the Houghtalings said. They estimate they’re still owed over $400, and they want to tell their story because they’re afraid that the same thing is happening to others who are too scared come forward.

INFLATED INCOME
The Houghtalings aren’t exactly sure what happened in their case. The health care system is Byzantine, and they are simple people. They suspect their Benzie County caseworker mistakenly registered a phantom $1,500 in monthly income in their file, bumping them into a higher income bracket and making them responsible for doctor and dental visit copays.

The couple said they noticed the problem in 2015, complained to their caseworker, and were assured that the problem would be corrected. But later they discovered the problem had not been corrected; they continued to get charged for co-pays, which Sandra Houghtaling said her husband insisted on paying because he believes in paying his bills, even if he doesn’t believe he owes them.

The Houghtalings said that, in trying to get refunds for the wrongly charged copays, they’ve gotten the runaround from the Benzie County office.

“They have never talked to us about it. They refuse. They say, ‘Oh, we don’t have nothing to do with that,’” Gary Houghtaling said. “They’ve given us probably a half a dozen different phone numbers, and we’ve called every one of them, and every one of them has said – ‘Pssst, Benzie County is the one that takes care of that.’ And you call him, and he says, ‘Oh no, they’re mistaken.’”

The couple’s income is $15,627.96 per year. That includes a $4,000 annuity Gary Houghtaling receives each year for a workman’s comp claim. The rest comes from a monthly $922 payment from Social Security and a $47 monthly pension earned from the years he spent as a union heavy equipment operator. When the $4,000 is pro-rated over 12 months, it adds up to a monthly income of $1,302.33.

The couple’s monthly income is important because, according to the 2017 poverty guidelines for the Healthy Michigan Plan, the monthly income threshold to receive care — without being responsible for a copay — is $1,334.00 per month for a family of two. The Houghtaling’s monthly income falls under that amount.

GOING WITHOUT CARE
Gary Houghtaling said the mix-up has forced him to forgo dental care. He gets his medical care through the Veterans Administration but his dental work is provided through the state.

“They had us on a dental program, and you pay according to what you make. Well, if you put the wrong figures in there — because we shouldn’t have been paying anything, and he had us paying $24 a month, plus anywhere from $25 to $60 or $70 co-pay for a dental appointment,” he said. “Fifty bucks out of my paycheck for something that’s not scheduled, and that’s it — I’m busted.”

The Houghtalings said they stopped complaining at the Benzie County office because their pleas were eventually met with ridicule, but in late 2016, they were told their paperwork had been corrected to reflect their actual income. Despite having paid previous copays, they believed they would move on and at least would not be charged in the future.

Then in December they received another copay bill for $48. The said that when they called the Healthy Michigan Plan office, they were told to call Benzie County. The couple said the continued runaround caused them stress, which caused them each health problems.

In April, the couple’s frustration boiled over. Sandra Houghtaling wrote a long, somewhat rambling and very angry letter to Nick Lyon, the state director of DHHS. It outlined the couple’s frustrations and repeatedly referenced her husband’s military service; Gary Houghtaling served in the Army in Germany during the Vietman war.

She wrote: “It is time to put a face to these series of blunders. HUMAN lives are on the other side of your forms you and your staff is required to file correctly. You must realize this statement.”

She included a blank sheet of paper and a stamped, self-addressed envelope so that Lyon could personally write an apology. 

TWO DIFFERENT ANSWERS
In July, the Houghtalings received responses from the Benzie County DHHS office and from the state DHHS offices. The letters offered conflicting explanations of what happened.

The state office offered an apology. In the state letter, dated July 10, department specialist Andrew Piper said a computer glitch caused the trouble.

“It appears there was a technical issue with our internal eligibility software, which caused a problem with the way income was being budgeted on your case,” Piper wrote. “For future reference, the exact issue involved incorrectly calculating income from your husband’s annuity, which had been pro-rated over a 12-month period. We were able to verify your co-payment amounts have been corrected through the issuance of refunds/adjustments.”

The letter goes on to say that they confirmed that the Benzie County office was aware of the glitch and would take action to prevent it from occurring in the future.

In a letter dated July 11, the Benzie County office offered a different explanation for the error.

That letter, written by Kristine Lagios, director of Benzie County branch of DHHS, explained that the reason the Houghtalings were at some points deemed responsible for copays was because of fluctuations in the federal poverty line, which is used to set income limits for benefits.

Lagios did not apologize to the couple. She wrote: “It does not appear that there have been any errors on the part of the Department of Health and Human Services. Please let me know if you need any further information. Again, thank you for your service to our country.”

Despite making no admission of an error, Lagios did write that the agency responsible for billing had overbilled them $21, for which they had been reimbursed.

The couple still has the check. The consider it an insult and don’t plan to cash it.

“We have over $400 worth of charges, and I don’t know where they come up with $21. I don’t know where they come up with their figures at all,” Gary Houghtaling said.

Lagios and Piper did not return messages seeking comment. Bob Wheaton, DHHS spokesman, said he couldn’t comment about a specific case because of confidentiality requirements.

“Generally speaking, I can tell you that when MDHHS becomes aware of any miscalculation that affects a client’s benefits or health-care coverage, the department takes actions to correct that situation so that the client receives the benefits for which he or she is eligible,” Wheaton said. 

MOVE NORTH TO BENZIE
The couple did not always live in poverty. They moved to Benzie County from downstate around Christmas of 1994. They purchased the historic 1912 Benzie County courthouse in Beulah on a land contract. They planned to turn it into a bed and breakfast but after three years ran out of money and had to walk away, losing what they had invested so far.

“We couldn’t get funding. I always paid cash for everything and didn’t have a trail, and banks weren’t going to lend us a thing,” Gary Houghtaling said. “All they’d give us was promises —

‘If you do this, we’ll consider it.’ If we’d do that, they’d say, ‘Well, do this then.’ And we’d do that. And this and that and this and that and this and that. They kept us jumping for three years.”

Finally, they ran out of money and had to walk away from the contract.

The couple decided to build a house on land out in the country, their Homestead Township property, which they had purchased at the same time they had attempted to buy the courthouse.

They had bought the Homestead Township property on land contract for $99 down and $99 per month as a backup plan. Today, they are very thankful they bought the land, because as long as they can pay the property taxes, they have a place to live.

The couple built their home themselves with scraps Gary found as he was working as a

carpenter. They core of the home is a cabin a friend gave them; it only needed to be moved from a lot on Crystal Lake, so Gary Houghtaling chain-sawed the building into eight-foot pieces, loaded them onto a truck, and hauled them out to his land.

Today, it’s a cozy cabin filled with books and records, a woodstove and, in the center, a tree.

Sandra Houghtaling said she wants to tell her story because she fears there are others who are having the same trouble.

“My thoughts are, if it’s happening to us on this level, how much more is it happening?” she said. “We are in this for everybody. I mean, we have the wherewithal to go ahead and put our faces forward. This is not the only case.”

LIFE IN POVERTY
The Houghtalings are not trapped only in poverty but also in the unfolding debate over health care in America. Progressives believe health care is a human right that should be available to everyone. Conservatives view health care as a commodity that — with exceptions — should be provided to those able to pay for it. The Houghtalings find themselves caught in the compromise between those positions.

For people who live in poverty, the unexpected loss of even a small amount of money can be devastating, said Gerri VanAntwerp, executive director of Benzie Area Christian Neighbors.

“Twenty-five dollars to someone who has hundreds might not be a lot, but $25 to someone who has $50 is a tremendous amount,” she said.

What’s more, for people who live in poverty, navigating the bureaucracy in order to receive benefits can be a perplexing and painful process.

“The pathway to all these services and advocating for yourself is often very difficult and very wary to many people,” VanAntwerp said. “Better-off people have so many tools and resources that people living in poverty don’t have.”

The troubles the Houghtaling face with the DHHS is just one aspect of the frustrations that come from dealing with the poverty bureaucracy.

Take the $4,000 annuity the couple receives every April. It’s considered part of the couple’s monthly income, but it doesn’t spend like monthly income, Gary Houghtaling said.

“That comes in nice. It works out really good, because of when it comes … I can pay my (property) taxes, and I’m not going to lose my house,” he said.

But the annual payment makes the couple eligible for fewer food stamps.

“I get less food stamps because they say I’m making more than I am actually making,” he said. “And then, when April gets here, they throw me off. They cancel me. Every year, I think two, three years, as soon as I get that $4,000 check, even though it’s all in the records, everything’s cancelled. They cancel me every April. And then you have to start all over. And it takes two, three months to get back on the program.”

Sandra Houghtaling said she’s resigned to not have health care.

“I’ve learned to use herbs because I don’t give us a chance at having any more health care as far as the government’s concerned,” she said. “They’re not going to do it. They just hope we die. I mean, short of dying, what do you want us to do? We’ve filled out all of your papers. We still have this problem. Like I have maintained, I just want to get out of the health care system and be on my own.”

 

 

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